CMAJ: Less than one in five urgent readmissions potentially avoidable

As hospital readmissions become a predictor of high-quality care at hospitals, Canadian researchers set out to find whether urgent readmissions can be avoided. Results of the study showed that the number of potentially avoidable readmissions was low. In fact, they were 16 percent of all readmissions, according to results published Aug. 22 in the Canadian Medical Association Journal.

While unplanned hospital readmissions are being used more frequently to gauge the quality of care at hospitals, Carl van Walraven, MD, MSc, a senior scientist of clinical epidemiology at the Ottawa Hospital Research Institute in Ottawa, Canada, told Cardiovascular Business that it is still unclear what proportion of urgent readmissions may be avoided.

To help answer that question, he and colleagues evaluated 4,812 patients who were recently discharged from medical or surgical services across 11 hospitals in Ontario between October 2002 and July 2006 to decipher the rate of possibly avoidable readmissions. According to van Walraven, summaries of the readmissions were evaluated by at least four practicing physicians using standardized methods to judge whether the readmission was an adverse event and whether that event could have been avoided.

The researchers reported that 649 patients had an urgent readmission within six months of hospital discharge, and 16 percent of those could have been avoided, he said.

Van Walraven said the current research was necessary because the number of potentially avoidable readmissions is not yet clear, despite 33 previous clinical trials that have attempted to define this figure. He said that the previous studies used variable methodology that he and colleagues questioned. “We used methods that seemed to be more stringent during this study,” van Walraven noted.

The current study showed that the proportion of urgent readmissions was low. Readmissions within four days after discharge were classified as avoidable, as compared with 6.2 percent of readmissions beyond 135 days after discharge. Additionally, almost half of the urgent readmissions occurred within a month after discharge, and 70 were potentially avoidable.

“This statistic is important because some people now use readmission as a method to explore or try to measure the quality of care delivered by a hospital,” van Walraven offered. “If the hospital has a low urgent readmission rate, that describes that as a high quality of care. But that approach is only useful if the proportion of urgent readmissions that are avoidable is very high,” he said.

While the number of potentially avoidable readmissions was low, the number varied by hospital, 7.5 percent to 22.5 percent. The researchers however noted that they found no association between the proportion of patients who had urgent readmission and those who had avoidable readmission.

“The most important conclusion is that we need to keep this statistic in mind when we are examining urgent readmission rates,” said van Walraven. “When you are looking at a hospital, a service or an individual physician, you must keep in mind that this study shows that less than one in five of these readmissions are potentially avoidable.”

Van Walraven and colleagues concluded that various interventions, including closer follow-up and better communication between physicians, can help reduce the risk of readmission and said that these interventions should be tailored to individual patient cases.

The authors cautioned that the study identified readmissions that were potentially avoidable, not definitely avoidable. They concluded that future studies should determine whether the readmission itself is avoidable if the preventable adverse event did not occur.